|
HC SOM CHROMOGRANIN A
|
Facility
|
OP
|
$17.65
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
900911458
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$189.98 |
| Rate for Payer: Adventist Health Commercial |
$3.53
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.98
|
| Rate for Payer: Blue Shield of California Commercial |
$167.44
|
| Rate for Payer: Blue Shield of California EPN |
$134.30
|
| Rate for Payer: Cash Price |
$17.65
|
| Rate for Payer: Cash Price |
$17.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.89
|
| Rate for Payer: Dignity Health Senior |
$20.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.47
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.93
|
| Rate for Payer: Heritage Provider Network Senior |
$10.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.22
|
| Rate for Payer: Multiplan Commercial |
$13.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.81
|
| Rate for Payer: TriValley Medical Group Senior |
$20.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
|
HC SOM CHROMOGRANIN A
|
Facility
|
IP
|
$17.65
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
900911458
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$13.24 |
| Rate for Payer: Adventist Health Commercial |
$3.53
|
| Rate for Payer: Cash Price |
$17.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.95
|
| Rate for Payer: Heritage Provider Network Senior |
$11.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.41
|
| Rate for Payer: Multiplan Commercial |
$13.24
|
|
|
HC SOM CHROMOSOMAL MICROARRAY
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
CPT 81229
|
| Hospital Charge Code |
900914668
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$107.62 |
| Max. Negotiated Rate |
$1,740.00 |
| Rate for Payer: Adventist Health Commercial |
$190.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$507.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$652.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,740.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,276.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,160.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.62
|
| Rate for Payer: Blue Shield of California Commercial |
$579.50
|
| Rate for Payer: Blue Shield of California EPN |
$463.60
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$617.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,740.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,276.00
|
| Rate for Payer: Dignity Health Senior |
$1,160.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$617.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,160.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$588.05
|
| Rate for Payer: Heritage Provider Network Senior |
$588.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,160.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$453.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,334.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,461.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,461.60
|
| Rate for Payer: Multiplan Commercial |
$712.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,160.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1,160.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,252.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,252.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,740.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,276.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,160.00
|
|
|
HC SOM CHROMOSOMAL MICROARRAY
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
CPT 81229
|
| Hospital Charge Code |
900914668
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$171.95 |
| Max. Negotiated Rate |
$712.50 |
| Rate for Payer: Adventist Health Commercial |
$190.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.15
|
| Rate for Payer: Heritage Provider Network Senior |
$643.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.50
|
| Rate for Payer: Multiplan Commercial |
$712.50
|
|
|
HC SOM CHROMOSOME ANALYSIS BREAKAGE
|
Facility
|
IP
|
$243.11
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912554
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$182.33 |
| Rate for Payer: Adventist Health Commercial |
$48.62
|
| Rate for Payer: Cash Price |
$243.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$164.59
|
| Rate for Payer: Heritage Provider Network Senior |
$164.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.78
|
| Rate for Payer: Multiplan Commercial |
$182.33
|
|
|
HC SOM CHROMOSOME ANALYSIS BREAKAGE
|
Facility
|
OP
|
$243.11
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912554
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$206.64 |
| Rate for Payer: Adventist Health Commercial |
$48.62
|
| Rate for Payer: Aetna of CA Gatekeeper |
$129.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$167.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$182.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.56
|
| Rate for Payer: Blue Shield of California Commercial |
$37.25
|
| Rate for Payer: Blue Shield of California EPN |
$29.95
|
| Rate for Payer: Cash Price |
$243.11
|
| Rate for Payer: Cash Price |
$243.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$158.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$206.64
|
| Rate for Payer: Dignity Health Senior |
$206.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$150.49
|
| Rate for Payer: Heritage Provider Network Senior |
$150.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$115.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.18
|
| Rate for Payer: Multiplan Commercial |
$182.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$206.64
|
| Rate for Payer: Vantage Medical Group Senior |
$206.64
|
|
|
HC SOM CHROMOSOME ANALYSIS MARROW
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910601
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$807.50 |
| Rate for Payer: Adventist Health Commercial |
$190.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$507.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$652.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$807.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$522.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$712.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.56
|
| Rate for Payer: Blue Shield of California Commercial |
$37.25
|
| Rate for Payer: Blue Shield of California EPN |
$29.95
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$617.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$807.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$807.50
|
| Rate for Payer: Dignity Health Senior |
$807.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$617.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$588.05
|
| Rate for Payer: Heritage Provider Network Senior |
$588.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$453.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$665.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$665.00
|
| Rate for Payer: Multiplan Commercial |
$712.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$807.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$807.50
|
| Rate for Payer: Vantage Medical Group Senior |
$807.50
|
|
|
HC SOM CHROMOSOME ANALYSIS MARROW
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910601
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$171.95 |
| Max. Negotiated Rate |
$712.50 |
| Rate for Payer: Adventist Health Commercial |
$190.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.15
|
| Rate for Payer: Heritage Provider Network Senior |
$643.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.50
|
| Rate for Payer: Multiplan Commercial |
$712.50
|
|
|
HC SOM CHROMOSOME ANALYSIS WHOLE BLOOD
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910752
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$70.77 |
| Max. Negotiated Rate |
$293.25 |
| Rate for Payer: Adventist Health Commercial |
$78.20
|
| Rate for Payer: Cash Price |
$391.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$264.71
|
| Rate for Payer: Heritage Provider Network Senior |
$264.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.75
|
| Rate for Payer: Multiplan Commercial |
$293.25
|
|
|
HC SOM CHROMOSOME ANALYSIS WHOLE BLOOD
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910752
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$332.35 |
| Rate for Payer: Adventist Health Commercial |
$78.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$208.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$268.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$332.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$215.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$293.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.56
|
| Rate for Payer: Blue Shield of California Commercial |
$37.25
|
| Rate for Payer: Blue Shield of California EPN |
$29.95
|
| Rate for Payer: Cash Price |
$391.00
|
| Rate for Payer: Cash Price |
$391.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$254.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$332.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$332.35
|
| Rate for Payer: Dignity Health Senior |
$332.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$242.03
|
| Rate for Payer: Heritage Provider Network Senior |
$242.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$186.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$273.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$273.70
|
| Rate for Payer: Multiplan Commercial |
$293.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$332.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$332.35
|
| Rate for Payer: Vantage Medical Group Senior |
$332.35
|
|
|
HC SOM CHROMOSOMES CHORIONIC VILLUS
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912549
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$213.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$274.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$340.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.56
|
| Rate for Payer: Blue Shield of California Commercial |
$37.25
|
| Rate for Payer: Blue Shield of California EPN |
$29.95
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$260.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$340.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$340.00
|
| Rate for Payer: Dignity Health Senior |
$340.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$247.60
|
| Rate for Payer: Heritage Provider Network Senior |
$247.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$190.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$280.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$280.00
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$340.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$340.00
|
| Rate for Payer: Vantage Medical Group Senior |
$340.00
|
|
|
HC SOM CHROMOSOMES CHORIONIC VILLUS
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912549
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$72.40 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$270.80
|
| Rate for Payer: Heritage Provider Network Senior |
$270.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.00
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
|
|
HC SOM CHROMOSOMES LYMPHOID
|
Facility
|
OP
|
$36.56
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912548
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.62 |
| Max. Negotiated Rate |
$170.56 |
| Rate for Payer: Adventist Health Commercial |
$7.31
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.56
|
| Rate for Payer: Blue Shield of California Commercial |
$37.25
|
| Rate for Payer: Blue Shield of California EPN |
$29.95
|
| Rate for Payer: Cash Price |
$36.56
|
| Rate for Payer: Cash Price |
$36.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.08
|
| Rate for Payer: Dignity Health Senior |
$31.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.63
|
| Rate for Payer: Heritage Provider Network Senior |
$22.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.59
|
| Rate for Payer: Multiplan Commercial |
$27.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.08
|
| Rate for Payer: Vantage Medical Group Senior |
$31.08
|
|
|
HC SOM CHROMOSOMES LYMPHOID
|
Facility
|
IP
|
$36.56
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912548
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.62 |
| Max. Negotiated Rate |
$27.42 |
| Rate for Payer: Adventist Health Commercial |
$7.31
|
| Rate for Payer: Cash Price |
$36.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.75
|
| Rate for Payer: Heritage Provider Network Senior |
$24.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.14
|
| Rate for Payer: Multiplan Commercial |
$27.42
|
|
|
HC SOM CHROMOSOMES SKIN BIOPSY
|
Facility
|
IP
|
$276.95
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912547
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$50.13 |
| Max. Negotiated Rate |
$207.71 |
| Rate for Payer: Adventist Health Commercial |
$55.39
|
| Rate for Payer: Cash Price |
$276.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$187.50
|
| Rate for Payer: Heritage Provider Network Senior |
$187.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.24
|
| Rate for Payer: Multiplan Commercial |
$207.71
|
|
|
HC SOM CHROMOSOMES SKIN BIOPSY
|
Facility
|
OP
|
$276.95
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912547
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$235.41 |
| Rate for Payer: Adventist Health Commercial |
$55.39
|
| Rate for Payer: Aetna of CA Gatekeeper |
$148.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$190.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$235.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$152.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$207.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.56
|
| Rate for Payer: Blue Shield of California Commercial |
$37.25
|
| Rate for Payer: Blue Shield of California EPN |
$29.95
|
| Rate for Payer: Cash Price |
$276.95
|
| Rate for Payer: Cash Price |
$276.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$180.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$235.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$235.41
|
| Rate for Payer: Dignity Health Senior |
$235.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$171.43
|
| Rate for Payer: Heritage Provider Network Senior |
$171.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$132.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$193.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$193.87
|
| Rate for Payer: Multiplan Commercial |
$207.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$235.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$235.41
|
| Rate for Payer: Vantage Medical Group Senior |
$235.41
|
|
|
HC SOM CHRONIC URTICARIA INDEX
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 86343
|
| Hospital Charge Code |
900912840
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.96 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$108.32
|
| Rate for Payer: Heritage Provider Network Senior |
$108.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
|
|
HC SOM CHRONIC URTICARIA INDEX
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 86343
|
| Hospital Charge Code |
900912840
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$85.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$109.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.08
|
| Rate for Payer: Blue Shield of California Commercial |
$100.28
|
| Rate for Payer: Blue Shield of California EPN |
$80.43
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$104.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.71
|
| Rate for Payer: Dignity Health Senior |
$12.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$99.04
|
| Rate for Payer: Heritage Provider Network Senior |
$99.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$76.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.70
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.46
|
| Rate for Payer: TriValley Medical Group Senior |
$12.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.71
|
| Rate for Payer: Vantage Medical Group Senior |
$12.46
|
|
|
HC SOM CHRTI CULTURE 02
|
Facility
|
IP
|
$173.04
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900915283
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.32 |
| Max. Negotiated Rate |
$129.78 |
| Rate for Payer: Adventist Health Commercial |
$34.61
|
| Rate for Payer: Cash Price |
$173.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$117.15
|
| Rate for Payer: Heritage Provider Network Senior |
$117.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.26
|
| Rate for Payer: Multiplan Commercial |
$129.78
|
|
|
HC SOM CHRTI CULTURE 02
|
Facility
|
OP
|
$173.04
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900915283
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.32 |
| Max. Negotiated Rate |
$1,132.59 |
| Rate for Payer: Adventist Health Commercial |
$34.61
|
| Rate for Payer: Aetna of CA Gatekeeper |
$92.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,090.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,132.59
|
| Rate for Payer: Blue Shield of California EPN |
$908.43
|
| Rate for Payer: Cash Price |
$173.04
|
| Rate for Payer: Cash Price |
$173.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$112.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.80
|
| Rate for Payer: Dignity Health Senior |
$140.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.48
|
| Rate for Payer: EPIC Health Plan Medicare |
$140.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$107.11
|
| Rate for Payer: Heritage Provider Network Senior |
$107.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$202.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$140.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$82.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$161.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$177.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$177.32
|
| Rate for Payer: Multiplan Commercial |
$129.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$140.73
|
| Rate for Payer: TriValley Medical Group Senior |
$140.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$151.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$151.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Vantage Medical Group Senior |
$140.73
|
|
|
HC SOM CIRC TUMOR PROS FLOW
|
Facility
|
OP
|
$325.24
|
|
|
Service Code
|
CPT 86152
|
| Hospital Charge Code |
900914391
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$58.87 |
| Max. Negotiated Rate |
$778.74 |
| Rate for Payer: Adventist Health Commercial |
$65.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$173.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$223.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$376.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$778.74
|
| Rate for Payer: Blue Shield of California Commercial |
$198.40
|
| Rate for Payer: Blue Shield of California EPN |
$158.72
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$211.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$376.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.86
|
| Rate for Payer: Dignity Health Senior |
$250.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.41
|
| Rate for Payer: EPIC Health Plan Medicare |
$250.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$201.32
|
| Rate for Payer: Heritage Provider Network Senior |
$201.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$155.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$288.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$315.98
|
| Rate for Payer: Multiplan Commercial |
$243.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$250.78
|
| Rate for Payer: TriValley Medical Group Senior |
$250.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$270.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$270.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$376.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.86
|
| Rate for Payer: Vantage Medical Group Senior |
$250.78
|
|
|
HC SOM CIRC TUMOR PROS FLOW
|
Facility
|
IP
|
$325.24
|
|
|
Service Code
|
CPT 86152
|
| Hospital Charge Code |
900914391
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$58.87 |
| Max. Negotiated Rate |
$243.93 |
| Rate for Payer: Adventist Health Commercial |
$65.05
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$220.19
|
| Rate for Payer: Heritage Provider Network Senior |
$220.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.31
|
| Rate for Payer: Multiplan Commercial |
$243.93
|
|
|
HC SOM CIRC TUMOR PROS MARK
|
Facility
|
OP
|
$325.24
|
|
|
Service Code
|
CPT 86153
|
| Hospital Charge Code |
900914392
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$58.87 |
| Max. Negotiated Rate |
$276.45 |
| Rate for Payer: Adventist Health Commercial |
$65.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$173.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$223.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$276.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$178.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$243.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$194.16
|
| Rate for Payer: Blue Shield of California Commercial |
$198.40
|
| Rate for Payer: Blue Shield of California EPN |
$158.72
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$211.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$276.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$276.45
|
| Rate for Payer: Dignity Health Senior |
$276.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$201.32
|
| Rate for Payer: Heritage Provider Network Senior |
$201.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$155.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$227.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$227.67
|
| Rate for Payer: Multiplan Commercial |
$243.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$162.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$162.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$276.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$276.45
|
| Rate for Payer: Vantage Medical Group Senior |
$276.45
|
|
|
HC SOM CIRC TUMOR PROS MARK
|
Facility
|
IP
|
$325.24
|
|
|
Service Code
|
CPT 86153
|
| Hospital Charge Code |
900914392
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$58.87 |
| Max. Negotiated Rate |
$243.93 |
| Rate for Payer: Adventist Health Commercial |
$65.05
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$220.19
|
| Rate for Payer: Heritage Provider Network Senior |
$220.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.31
|
| Rate for Payer: Multiplan Commercial |
$243.93
|
|
|
HC SOM CITRIC ACID URINE
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
900911053
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
